Provider Demographics
NPI:1922571926
Name:DE LA FUENTE, ADRIANA (PA-C)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:DE LA FUENTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:475 BILTMORE WAY STE 109
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5724
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:415-520-6633
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62973363A00000X
FLPA9111893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant